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cns > Session 12 - mood disorders > Flashcards

Session 12 - mood disorders Flashcards

1
Q

what are the 2 broad classes of mood/affective disorders

A
  • depressive disorders
  • Bipolar disorders
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2
Q

How long do patients usually have the symptoms of depressive disorders and what are the core symptoms and some other features?

A
  • 2 weeks
  • Low mood, lack of energy, lack of enjoyment and interest
  • Depressive thoughts - suicidal ideation
  • Somatic symptoms/biological symptoms - lack of appetite, pain
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3
Q

What may patients have in severe cases of depressive disorders?

A

psychotic symptoms eg. Delusions

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4
Q

What is an adjustment reaction?

A
  • it occurs after some kind of traumatic event and has fewer somatic features compared to depression
  • These reactions don’t last as long and have a fluctuating course
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5
Q

What is the difference between an adjustment reaction and depression?

A
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6
Q

Which class of disorder is mania seen in?

A

bipolar disorder

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7
Q

What are the clinical features of mania?

A
  • elated mood - they can become irritable as people aren’t able to keep up with them
  • Increased energy
  • Pressure of speech - speaking quickly. If you ask them a question or ask them to stop, they just ignore you or raise their voice
  • Decreased need for sleep - they say that they’re sleeping well and are fine but in reality are only sleeping for a couple of hours
  • Flight of ideas - racing thought
  • Normal social inhibitions are lost - might do out of character actions eg. Gambling
  • Attention can’t be sustained
  • Self esteem is inflates (grandiose) - often grandiose - high sense of their own self worth eg. Think they can cure cancer
  • May have psychotic symptoms - in keeping with their mood
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8
Q

How do you diagnose bipolar affective disorder?

A

2 episodes of a mood disorder at least one of which is mania or hypomania

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9
Q

What is hypomania?

A

the symptoms are the same as mania but don’t necessarily reach the full diagnostic criteria for mania

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10
Q

What is the difference between bipolar 1 and bipolar 2?

A
  • bipolar 1 = discrete episodes of mania only or mania and depression (full manic episodes with or without depression)
  • bipolar 2 = discrete episodes of hypomania or hypomania and depression
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11
Q

can you be diagnosed without ever having been diagnosed with depression?

A

yes

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12
Q

what does euthymia mean?

A
  • this is the aim where a patient isn’t manic or depressed
  • steady state between mania and depression
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13
Q

what are some physical causes of psychiatric symptoms that must be excluded?

A
  • depression physical differentials:
    • hypothyroidism
    • B12 deficiency
    • chronic disease eg. renal, CVS, liver failure
    • anaemia
    • substance misuse eg. alcohol, cannabis and stimulants
    • hypoactive delirium - where a patient is inactive, has motor retardation, slowing of speech, sleepy and slow
  • mania physical differentials:
    • hyperthryoidism
    • delirium
    • iatrogenic eg. steroid induced
    • infection eg. encephalitis, syphilis, HIV
    • head injury
    • intoxication eg with stimulates (eg. amphetamines)
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14
Q

which brain structures are involved in brain disorders?

A
  • the limbic system
  • frontal lobe
  • basal ganglia
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15
Q

circuits: what is the main hypothesis of mood?

A
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16
Q

what are the functions of the frontal lobe?

A
  • motor function
  • language (Broca’s area)
  • executive functions - planning, coordination activities, working through tasks with stages
  • attention
  • memory - feeds into limbic system
  • mood
  • social and moral reasoning
17
Q

what are the functions of the pre frontal cortex?

A
  • ventromedial prefrontal cortex - generation of emotions
  • orbital pre frontal cortex - emotional responses - possibly via connection with the amygdala
18
Q

when the pre frontal cortex doesn’t control emotions properly what effect does this have?

A
  • it dampens the emotional response
  • in severe depression it can be difficult to get them to even smile - this is a similar presentation to a front lobe brain injury
  • mania - rapidly changing emotions.
19
Q

what are the possible frontal lobe changes during depression and bipolar?

A
20
Q

what are the functions of the basal ganglia?

A
  • motor function
  • psychological function - emotion, cognition, behaviour
21
Q

what are some motor disorders associated with malfunction of the basal ganglia?

A
  • parkinson’s
  • wilson’s
  • huntington’s
22
Q

what are possible basal ganglia changes during mood disorders?

A
23
Q

Explain which areas of the brain cause each symptom in depression and mania?

A
  • prefrontal cortex - slowing of thought, executive dysfunction (eg. unable to get tasks completed) , altered emotional processing
  • amygdala - abnormal emotional processing
  • basal ganglia - impaired incentive behaviour, psychomotor changes
24
Q

what are the 2 main neurotransmitters involved in mood depression?

A
  • serotonin
  • noradrenaline (norepinephrine)
  • these are both monoamines
25
Q

what does the monoamine hypothesis suggest?

A

that depressive disorder is due to abnormality in the availability of these neurotransmitters

26
Q

where is serotonin produced and where is it distributed to?

A
  • in the raphe nuclei in the brainstem
  • transported to cortical areas and the limbic system
27
Q

roles of serotonin?

A
  • sleep
  • impulse control
  • appetite
  • mood
28
Q

what is the role of serotonin in depression and what is the evidence to support this?

A
  • low in depression
  • drugs that increase serotonin in brain treat depression
  • 5HIAA which is a metabolite of serotonin is low in the CSF of patients with depression (esp in those who have attempted suicide)
  • depletion of tryptophan which is a pre cursor serotonin causes depression
29
Q

what evidence might contraindicate the involvement on serotonin in depression?

A
  • despite the levels of serotonin rising rapidly following the use of drugs such as SSRIs, symptoms only improve over the course of weeks to months
  • might be that antidepressants act to change the levels of other neurochemicals, maybe even stimulating neurogenesis in the hippo campus through growth factors such. as brain derived neurotrophic factors
30
Q

where is noradrenaline produced and where is it distributed to?

A
  • in the locus coeruleus of the brain stem (pons)
  • to the cortex and limbic system
31
Q

roles of noradrenaline in the brain and what can too much NA lead to?

A
  • mood, arousal, memory, fight or flight
  • too much NA → can lead to addictive behaviours eg. gambling
32
Q

role of NA in depression and evidence?

A
  • decreased in depression
  • antidepressants that increase NA treat depression
  • patients who have recovered form depression but still have low levels of noradrenaline are at higher risk of relapse
  • post mortem studies → lower levels of noradrenaline the brains of those with depression
33
Q

what are the functions of the limbic system?

A
  • functions in emotion, memory and motivation
  • it acts by influencing the endocrine system and the autonomic nervous system
  • it’s evident that the limbic system is involved in depression because there’s a lack of ability to store memories and a lack of motivation
34
Q

what is the main emotional circuit in this system known as and what is this circuit also responsible for?

A
  • papez circuit
  • this circuit is also responsible for memory consolidation where the hippocampus is able to induce long term potentiation in the cortex to lay down long term memory
35
Q

what is the limbic system made up of?

A
  • hippocampus
  • amygdala - role in the emotional attachment of memories
  • cingulate gyrus - involved in decision-making and emotional regulation
  • thalamus
  • hypothalamus
  • basal ganglia
36
Q

what are some possible changes in the limbic system during depression and bipolar?

A

cns (7 decks)

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